This proposal requests continued support for the Medical Scientist Training Program (MSTP) at the Vanderbilt University School of Medicine. The primary goal of the Vanderbilt MSTP is to identify, mentor, and foster the careers of a diverse workforce of superior future leaders in academic medicine who are dedicated to improving human health through research, clinical activities, and leadership. Our joint MD/PhD program is based on rigorous training in clinical medicine and scientific inquiry. Core program elements developed specifically for dual-degree students include a foundational course in research, a literature-based seminar series, the Clinical Preceptorship Program, Data Club, leadership workshops, a career development workshop, the Physician- Scientist Speaker Series, extensive near-peer mentoring, and an annual retreat. Students receive formal instruction in responsible conduct of research and newly developed rigor and reproducibility throughout the curriculum. An innovative advising college program offers opportunities for vertical integration of faculty members, post-graduate physician-scientist trainees, and MSTP students. Current students hone their leadership skills by playing key roles in student recruitment, program administration, and curriculum development. 70% of our total graduates with established careers hold academic or private-sector research positions, including the founding president of Gladstone Institute, 3 deans, 3 department chairs, 26 full professors, and 18 industry leaders. More recent graduates still in training are in superb residencies and fellowships. The 103 current trainees come from 57 colleges and universities distributed across North America. Our increasing applicant pool results from concerted recruiting efforts, including those focused on the recruitment of students from groups underrepresented in medicine. In the current year, 475 applications have been received, from which 14 students will be selected to enter the incoming class. The educational environment for physician- scientists at Vanderbilt University is outstanding and currently Vanderbilt is ranked #8 in NIH funding. Building on established strengths in biomedical informatics, cancer biology, cell biology, clinical pharmacology, diabetes, neurosciences, toxicology, drug discovery, genetics, chemical and physical biology, imaging sciences, microbial pathogenesis, pharmacogenomics, and vaccine science. New areas of research emphasis include addiction, immunobiology, inflammation and cancer, precision medicine, stem cell biology, quantitative systems biology, and structural biology. We are building on this very solid foundation in increasing the size of the program to a steady state of 113 students over the next decade. Based on the commitment of our leadership team, the strength of our applicant pool, enhanced opportunities for physician-scientist training, a longstanding institutional commitment to the education of Vanderbilt MSTP leaders in biomedical research, and the success of our graduates in academic medicine, this proposal requests an increase in NIH-funded positions to 26 for the 5-year project period.